1740641455 NPI number — NTTR MEDICAL LLC

Table of content: (NPI 1740641455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740641455 NPI number — NTTR MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NTTR MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740641455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9506 W 149TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66221-8202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-302-5188
Provider Business Mailing Address Fax Number:
913-825-6358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14433 W 86TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-4178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-634-3540
Provider Business Practice Location Address Fax Number:
913-825-6358
Provider Enumeration Date:
03/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GHOSHEH
Authorized Official First Name:
WADDAH
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
913-634-3540

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0431411 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1023159522 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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